Pioneers at the sharp end of medicine

HE “never wasted a word, a drop of ink or of blood,” according to one of his apprentices. And patients of 19th century surgeon James Syme must have been grateful for that, because the last thing you’d want in the days before anaesthetic was a doctor who stopped to chat or write notes mid-operation. The idea of going under the knife while fully conscious might fill us with horror these days but until just over 150 years ago, there was no other option. And with a four and a half pound tumour disfiguring his face, 19th century Coldstream man Robert Penman was desperate for a surgeon willing to attempt the operation, whatever the risks or pain. Luckily for him, he was within striking distance of Edinburgh, where some of the world’s foremost surgeons and medical experts of the day lived.

In July 1828 James Syme, with his patient sitting in an ordinary chair, removed the tumour in 24 minutes. Robert Penman not only survived but lived another 30 years, emigrated to the United States and disguised what was left of his deformity with a bushy beard.

Syme, later professor of clinical surgery at Edinburgh University, wasn’t even the fastest. West Lothian-born Robert Liston, a one-time partner of Syme, could amputate a leg in 28 seconds.

They are just two of the extraordinary medical men and women pioneers who people the pages of a new book, Scottish Medicine: An Illustrated History. Written by five authors, the book covers the gruesome, bizarre, uplifting and groundbreaking tales which make up thousands of years of medicine in Scotland.

The book has taken six years of research and writing, with all technical language and jargon banned, according to one of the authors, retired Edinburgh surgeon Iain Macintyre. The result is a very readable, quirky, albeit hefty tome in which Edinburgh dominates.

“We have been at great pains to make this a history of medicine in Scotland, not Edinburgh,” explains Mr Macintyre. “But there is no getting away from the fact that the contribution of Edinburgh is huge.”

One theme which comes across in the book is how medics even in the earliest days were at pains to take care of the impoverished.

“I think that’s what makes Scottish medicine so distinctive,” says Mr Macintyre. “It didn’t happen in other European countries. And it continued into the 20th century – when it came to the vote on the new national health service, English doctors voted overwhelmingly against it and Scottish doctors voted in favour.”

Even as far back as 1710, the poor sick could expect help from the authorities – in that year, Edinburgh Town Council paid £40 for Jean Beaton, a woman in receipt of poor relief, for the amputation of her leg – and later in the year another £3 for a timber leg.

But it was the Enlightenment which really transformed the medical scene. Even Mr Macintyre, 67, a surgeon at the Western General, then the Royal Infirmary until he retired in 2004, was astounded by the achievements. “There wasn’t really a major medical figure, but between them they made a huge contribution.”

Edinburgh doctor William Cullen wrote a seminal work on the classification of diseases and introduced the word neuroses to the world, while Robert Liston, originally from West Lothian, performed the first operation on a patient under ether in 1846. James Young Simpson’s pioneering use of chloroform is well known but it was one Thomas Latta, a Leith physician, who worked out that intravenous infusions could save the lives of dehydrated patients during a cholera outbreak in the 1840s.

The book ends in a 21st century where health care is free, and treatments have advanced beyond the imaginations of those early doctors. And overall, says Mr Macintyre, it is a health service which we should celebrate. “It has grunts and squeaks in a lot of places. But for most people, most of the time it delivers. We should be proud of it and we should be grateful for it.”

n Scottish Medicine: An Illustrated History by Helen Dingwall, David Hamilton, Iain Macintyre, Morrice McCrae and David Wright is published by Birlinn, £30